title: The deteriorating ward patient: a Swedish-Australian comparison.
abstract: OBJECTIVE
  Most centres in Europe have not introduced a rapid response team (RRT), partly because of concerns that data from other health-care systems may not be relevant. We tested whether patient characteristics and outcomes for deteriorating patients differ between two health-care systems separated by distance and culture.
  
  
  METHODS
  We obtained data from 3,063 RRT calls: 815 calls at Karolinska University Hospital (Sweden) and 2,248 calls at Austin Hospital (Australia) and compared demographic and clinical data, as well as outcomes for patients reviewed by a RRT.
  
  
  RESULTS
  At Karolinska, 46.9% of patients were female compared with 45.1% at Austin. Mean age was 66.5 years versus 69.4 years. The unit of admission was surgical/medical in 49.1%/50.9% versus 48.8%/51.1% of patients, respectively. Overall, 56.7% versus 55.8% of the calls were out-of-hours (1700-0800 hours). There was a predominance of respiratory triggers at both centres and the "worried" criterion was frequently used in both hospitals (17.2% versus 14.4%) as a trigger for RRT activation. Overall, 30-day mortality was 27.7% versus 29.4% and allocation of Limitations of Medical Treatment (LOMT) orders was 34.2% versus 30.8%. The allocation of LOMT orders was influenced by the RRT in 14.4% versus 12.6% of cases.
  
  
  CONCLUSIONS
  In two different health-care systems separated by geography, language, culture and organizational features, the characteristics of deteriorating ward patients, their disposal and outcomes were similar, suggesting that the care of the deteriorating ward patient is a global problem in modern hospitals and confirming that their hospital mortality is high.
authors.affiliation: Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care, Karolinska Institutet, 17176 Stockholm, Sweden. gabriella.jaderling@karolinska.se
authors.forename: Gabriella
authors.initials: G
authors.lastname: Jäderling
authors.forename: Paolo
authors.initials: P
authors.lastname: Calzavacca
authors.forename: Max
authors.initials: M
authors.lastname: Bell
authors.forename: Claes-Roland
authors.initials: CR
authors.lastname: Martling
authors.forename: Daryl
authors.initials: D
authors.lastname: Jones
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
authors.forename: David
authors.initials: D
authors.lastname: Konrad
mesh_terms: D000368:Aged; D016638:Critical Illness / Q000401:mortality / Q000451:nursing*; D003695:Delivery of Health Care; D018450:Disease Progression; D005260:Female; D017052:Hospital Mortality; D057209:Hospital Rapid Response Team / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012720:Severity of Illness Index; D013548:Sweden; D014739:Victoria